Comparison of Performance of Two Clinical Scales To Diagnose the Post-Thrombotic Syndrome: Correlation with Patient-Reported Disease Burden and Valvular Reflux.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4114-4114
Author(s):  
Susan R. Kahn ◽  
Sylvie Desmarais ◽  
Thierry Ducruet ◽  
Louise Arsenault ◽  
Jeffrey S. Ginsberg ◽  
...  
Keyword(s):  
Severe Disease ◽  
Chronic Venous Disease ◽  
Leg Pain ◽  
Venous Disease ◽  
Objective Criterion ◽  
Clinical Scales ◽  
Post Thrombotic Syndrome ◽  
Sf 36 ◽  
Patient Reported ◽  
Disease Specific

Abstract Background and Objectives: There is no objective, criterion standard test to diagnose the post thrombotic syndrome (PTS). Two clinical scales have been used to classify deep vein thrombosis (DVT) patients as having or not having the PTS: the Villalta scale and the Ginsberg measure. Differences in test characteristics of these measures could help explain differing rates of PTS reported after DVT. During a Canadian prospective cohort study of long-term outcomes after DVT (The VETO Study), we carried out a substudy to evaluate agreement between the Villalta and Ginsberg measures with regard to (1) proportion of patients classified as having PTS; (2) relation to patient-reported quality of life (QOL); and (3) correlation with venous valvular reflux, a physiological indicator of chronic venous disease. Methods: For this substudy, 259 VETO patients were assessed for ipsilateral PTS at the 1 year follow-up visit using both the Villalta scale (grades the severity of 5 symptoms and 6 signs from 0–3; a summed total score of ≥5 indicates PTS, and >14 or presence of ulcer indicates severe PTS) and the Ginsberg PTS measure (PTS defined by the presence of daily leg pain and swelling for ≥ 1 month, occurring 6 months or more after DVT, made worse by standing/walking and relieved by rest/leg elevation). Patients also completed generic (SF-36) and disease-specific (VEINES-QOL) QOL questionnaires and underwent a standardized ultrasound assessment for ipsilateral popliteal venous valvular reflux. We compared the proportion of patients classified as having PTS with each measure and assessed associations with QOL and valvular reflux. Results: Proportion of patients classified as having PTS was 96/259 (37%) (5/96 severe) with the Villalta scale and 21/259 (8.1%) with the Ginsberg measure (kappa 0.22; 95% CI 0.13, 0.32). Agreement between measures was better for severe PTS than for any PTS. For both measures, generic and disease specific-QOL scores were significantly lower (i.e. poorer QOL) in patients with vs. without PTS; however, QOL was worse in patients with Ginsberg-PTS than in patients with Villalta-PTS. Reflux was not significantly associated with PTS for either measure. Conclusions: The proportion of patients classified as having PTS was more than 4-fold higher with the Villalta measure than with the Ginsberg measure. While both measures showed a graded association with QOL, patients with Ginsberg-PTS had poorer QOL and higher mean Villalta scores, indicating that the Ginsberg measure identifies more severe disease. The presence of reflux was not discriminating for the diagnosis of PTS with either measure. Comparison of Villalta and Ginsberg PTS measures Villalta PTS Ginsberg PTS Mean (SD) YES NO p YES NO p Villalta score 8.3 (3.1) 1.6 (1.4) <.0001 9.2 (3.5) 3.6 (3.4) <.0001 SF-36 MCS (mental) 49.5 (12.1) 54.2 (8.3) .0007 47.3 (12.6) 52.9 (9.7) 0.01 SF-36 PCS (physical) 39.7 (11.0) 49.1 (10.0) <.0001 35.0 (12.4) 46.8 (10.8) <.0001 VEINES-QOL 48.6 (6.1) 56.2 (2.5) <.0001 44.1 (5.6) 54.2 (5.1) <.0001 Reflux present (%) 54.6% 44.0% 0.12 52.6% 46.2% 0.59

scholarly journals Quality of life in chronic venous patients who do or do not wear compressive stockings

2015 ◽  
Vol 14 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Bruno Vieira Melo ◽  
Priscilla Gabriela Moreira Dantas Tojal ◽  
Flávia de Jesus Leal ◽  
Renata Cardoso Couto
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Statistical Significance ◽  
Lower Limbs ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Sf 36 ◽  
Elastic Stockings ◽  
Disease Specific

BACKGROUND: Wearing elastic compression stockings is of considerable significance for patients with chronic venous disease (CVD), since their physiological effect is to improve venous hemodynamic parameters, making them a good treatment option that can impact on patients' quality of life. OBJECTIVE: To assess quality of life in patients with chronic venous disease who do or do not wear elastic stockings. METHODS: This was a cross-sectional observational study assessing a sample of 50 CVD patients of both sexes, divided into two groups, one who wear elastic stockings and another who do not. Primary variables were the domains of the SF-36 (Medical Outcomes Study Short-form 36) and AVVQ (Aberdeen Varicose Veins Questionnaire) and secondary variables were: age; sex; physical activity; educational level; profession; wearing elastic stockings (frequency, pressure and type); elevation of lower limbs; itching and CEAP classification. The SF-36 and AVVQ quality of life questionnaires were administered to patients. Statistical significance was set at p<0.05. RESULTS: Wearing elastic stockings proved beneficial for the quality of life of people with chronic venous disease. For the AVVQ disease-specific questionnaire the greatest improvements were in overall score (p=0.0028) and the extent of varicosity domain (p=0.000). The SF-36 domains role emotional (p=0.017) and functional capacity (p=0.000) both improved. CONCLUSIONS: Wearing elastic stockings is an effective treatment for CVD that improves disease-specific quality of life and also leads to improvements in general quality of life.

Comparison of disease-specific quality of life tools in patients with chronic venous disease

2013 ◽  
Vol 29 (10) ◽  
pp. 648-653 ◽  
Author(s):  
Mong-Loon Kuet ◽  
Tristan RA Lane ◽  
Muzaffar A Anwar ◽  
Alun H Davies
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Strong Correlation ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Life Questionnaire ◽  
The Relationship ◽  
Disease Specific

Objectives This work was presented as a poster in the American Venous Forum 25th Annual Meeting; 28 February 2013; Phoenix, Arizona, USA. Quality of life (QoL) is an important outcome measure in the treatment for chronic venous disease. The Aberdeen Varicose Vein Questionnaire (AVVQ) and the ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-14) are two validated disease-specific QoL questionnaires in current use. The aim of this study is to evaluate the relationship between the AVVQ and the CIVIQ-14 to enable better comparison between studies and to compare these disease-specific QoL tools with generic QoL and clinician-driven tools. Methods Adults attending our institution for management of their varicose veins completed the AVVQ, CIVIQ-14 and EuroQol-5D (EQ-5D). Clinical data, CEAP classification and the Venous Clinical Severity Score (VCSS) were collected. The relationship between the AVVQ and CIVIQ-14 scores was analysed using Spearman’s correlation. The AVVQ and CIVIQ-14 scores were also analysed with a generic QoL tool (EQ-5D) and a clinician-driven tool, the VCSS. Results One hundred patients, mean age 57.5 (44 males; 56 females), participated in the study. The median AVVQ score was 21.9 (range 0–74) and the median CIVIQ-14 score was 30 (range 0–89). A strong correlation was demonstrated between the AVVQ and CIVIQ-14 scores ( r = 0.8; p < 0.0001). Strong correlation was maintained for patients with C1-3 disease ( r = 0.7; p < 0.0001) and C4-6 disease ( r = 0.8; p < 0.0001). The VCSS correlated strongly with the AVVQ and CIVIQ-14 scores ( r = 0.7; p < 0.0001 and r = 0.7; p < 0.0001, respectively). Both the AVVQ and CIVIQ-14 scores correlated well with the EQ-5D score ( r = −0.5; p < 0.0001 and r = −0.7; p < 0.0001, respectively). Conclusions This study demonstrates that there is good correlation between two widely used varicose vein specific QoL tools (AVVQ and CIVIQ-14) across the whole spectrum of disease severity. Strong correlation exists between these disease-specific QoL tools and generic and clinician-driven tools. Our findings confirm valid comparisons between studies using either disease-specific QoL tool.

scholarly journals Post-thrombotic syndrome prevention – do we really know the predictive factors?

Phlebologie ◽  
2019 ◽  
Vol 48 (04) ◽  
pp. 245-250
Author(s):  
Tomasz Urbanek
Keyword(s):  
Predictive Factors ◽  
Current Knowledge ◽  
Late Complication ◽  
Early Mobilization ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Stocking ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
The Individual

AbstractDespite an increasing knowledge and experience regarding deep vein thrombosis (DVT) treatment, the rate of post-thrombotic syndrome (PTS) remains still relatively high. According to the current knowledge it is still difficult to predict on the individual basis, who of the DVT patients will develop PTS as late complication of the vein thrombosis. Among the factors influencing the higher prevalence of PTS, the ipsilateral DVT recurrence is of the highest importance. The other factors which should be mentioned are age, obesity, previous chronic venous disease as well as a proximal DVT location or lack of symptoms’ resolution in the early treatment. Looking for the most effective PTS prevention method several clinical trials were performed regarding pharmacological DVT treatment, use of early mobilization and medical compression stocking as well as an implementation of the thrombectomy and thrombolysis. This paper presents a review of the current knowledge regarding the PTS predictive factors and prevention.

Differentiating minimum clinically important difference for primary and revision lumbar fusion surgeries

2013 ◽  
Vol 18 (1) ◽  
pp. 102-106 ◽  
Author(s):  
Leah Y. Carreon ◽  
Kelly R. Bratcher ◽  
Chelsea E. Canan ◽  
Lauren O. Burke ◽  
Mladen Djurasovic ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Improvement ◽  
Lumbar Fusion ◽  
Minimum Clinically Important Difference ◽  
Leg Pain ◽  
Detectable Change ◽  
Minimum Detectable Change ◽  
Clinically Important Difference ◽  
Sf 36 ◽  
Patient Reported

Object Previous studies have reported on the minimum clinically important difference (MCID), a threshold of improvement that is clinically relevant for lumbar degenerative disorders. Recent studies have shown that pre- and postoperative health-related quality of life (HRQOL) measures vary among patients with different diagnostic etiologies. There is also concern that a patient's previous care experience may affect his or her perception of clinical improvement. This study determined if MCID values for the Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36), and back and leg pain are different between patients undergoing primary or revision lumbar fusion. Methods Prospectively collected preoperative and 1-year postoperative patient-reported HRQOLs, including the ODI, SF-36 physical component summary (PCS), and numeric rating scales (0–10) for back and leg pain, in patients undergoing lumbar spine fusion were analyzed. Patients were grouped into either the primary surgery or revision group. As the most widely accepted MCID values were calculated from the minimum detectable change, this method was used to determine the MCID. Results A total of 722 patients underwent primary procedures and 333 patients underwent revisions. There was no statistically significant difference in demographics between the groups. Each group had a statistically significant improvement at 1 year postoperatively compared with baseline. The minimum detectable change–derived MCID values for the primary group were 1.16 for back pain, 1.36 for leg pain, 12.40 for ODI, and 5.21 for SF-36 PCS. The MCID values for the revision group were 1.21 for back pain, 1.28 for leg pain, 11.79 for ODI, and 4.90 for SF-36 PCS. These values are very similar to those previously reported in the literature. Conclusions The MCID values were similar for the revision and primary lumbar fusion groups, even when subgroup analysis was done for different diagnostic etiologies, simplifying interpretation of clinical improvement. The results of this study further validate the use of patient-reported HRQOLs to measure clinical effectiveness, as a patient's previous experience with care does not seem to substantially alter an individual's perception of clinical improvement.

scholarly journals Patient-reported Outcomes in Chronic Gout: A Report from OMERACT 10

2011 ◽  
Vol 38 (7) ◽  
pp. 1452-1457 ◽  
Author(s):  
JASVINDER A. SINGH ◽  
WILL J. TAYLOR ◽  
LEE S. SIMON ◽  
PUJA P. KHANNA ◽  
LISA K. STAMP ◽  
...  
Keyword(s):  
Activity Limitation ◽  
Pain Patient ◽  
Specific Measure ◽  
Validation Data ◽  
Chronic Gout ◽  
Sf 36 ◽  
Patient Reported ◽  
Disease Specific Measure ◽  
Assessment Questionnaire ◽  
Disease Specific

Objective.To summarize the endorsement of measures of patient-reported outcome (PRO) domains in chronic gout at the 2010 Outcome Measures in Rheumatology Meeting (OMERACT 10).Methods.During the OMERACT 10 gout workshop, validation data were presented for key PRO domains including pain [pain by visual analog scale (VAS)], patient global (patient global VAS), activity limitation [Health Assessment Questionnaire-Disability Index (HAQ-DI)], and a disease-specific measure, the Gout Assessment Questionnaire version 2.0 (GAQ v2.0). Data were presented on all 3 aspects of the OMERACT filters of truth, discrimination, and feasibility. One PRO, health-related quality of life measurement with the Medical Outcomes Study Short-form 36 (SF-36), was previously endorsed at OMERACT 9.Results.One measure for each of the 3 PRO of pain, patient global, and activity limitation was endorsed by > 70% of the OMERACT delegates to have appropriate validation data. Specifically, pain measurement by VAS was endorsed by 85%, patient global assessment by VAS by 73%, and activity limitation by HAQ-DI by 71%. GAQ v2.0 received 30% vote and was not endorsed due to several concerns including low internal consistency and lack of familiarity with the measure. More validation studies are needed for this measure.Conclusion.With the endorsement of one measure each for pain, patient global, SF-36, and activity limitation, all 4 PRO for chronic gout have been endorsed. Future validation studies are needed for the disease-specific measure, GAQ v2.0. Validation for PRO for acute gout will be the focus of the next validation exercise for the OMERACT gout group.

scholarly journals Quality of Life in Patients with Vestibular Schwannomas Following Gross Total or Less than Gross Total Microsurgical Resection: Should We be Taking the Entire Tumor Out?

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 541-547 ◽  
Author(s):  
Michael J Link ◽  
Morten Lund-Johansen ◽  
Christine M Lohse ◽  
Colin L W Driscoll ◽  
Ehrling Myrseth ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Well Being ◽  
Sf 36 ◽  
Patient Reported ◽  
Microsurgical Resection ◽  
Disease Specific

Abstract BACKGROUND The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function. OBJECTIVE To analyze long-term quality of life (QoL) in a cohort of patients who received either GTR or less than GTR. METHODS Patients operated for vestibular schwannoma less than 3.0 cm in posterior fossa diameter at 1 of 2 international tertiary care centers were surveyed using generic and disease-specific QoL instruments. RESULTS A total of 143 patients were analyzed. GTR was performed in 122, and 21 underwent less than GTR. QoL was assessed at a mean of 7.7 yr after surgery (interquartile range: 5.7-9.6). Patients who underwent GTR had smaller tumors; otherwise, there were no baseline differences between groups. Patients who underwent GTR, after multivariable adjustment for baseline features and facial nerve and hearing outcomes, reported statistically significantly better Short Form Health Survey-36 (SF-36) physical and mental scores, Patient-Reported Outcomes Measurement Information System (PROMIS-10) physical and mental scores, and Penn Acoustic Neuroma Quality of Life (PANQOL) facial, energy, general health, and total scores compared to patients receiving less than GTR. CONCLUSION GTR is associated with better QoL using the general QoL measures SF-36 and PROMIS-10 and the disease-specific PANQOL, even after controlling for baseline and outcome differences. This is especially significant in the assessment of mental health, indicating there may indeed be a psychological advantage to the patient that translates to overall well-being to have the entire tumor removed if microsurgical resection is undertaken.

Importance of Patient-reported Outcomes in Chronic Venous Disorders

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 136-138 ◽  
Author(s):  
J J Guex
Keyword(s):  
Patient Reported Outcomes ◽  
Objective Assessment ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Personal Opinion ◽  
Patient Reported ◽  
Venous Disorders

The assessment of outcomes following treatment for chronic venous disease has been greatly improved over the last three decades. The personal opinion of the physician based on assessment of his own results has been replaced by more objective assessment based on well-defined criteria. The author describes and compares a number of different methods currently in use for this purpose.

scholarly journals The effects of water immersion and walking on leg volume, ankle circumference and epifascial thickness in healthy subjects with occupational edema

2021 ◽  
pp. 026835552098406
Author(s):  
Giovanni Mosti ◽  
Alberto Caggiati
Keyword(s):  
Water Immersion ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Life Study ◽  
Median Reduction ◽  
Time Period ◽  
Patient Reported ◽  
Before And After ◽  
Leg Edema ◽  
Working Day

Background Balneotherapy has been considered beneficial in patients with chronic venous disease due to patient-reported positive outcomes on improvement of symptoms and quality of life. Study aim: Assessing the effects of prolonged water immersion (WI) on leg edema and epifascial thickness and to compare these data with those achieved after continuous walking on ground. Material and methods On three consecutive days, 14 otherwise healthy volunteers (9 females, 5 males, mean age 53 ± 10 years) affected by occupational edema (OE), defined as the edema developing during the time period of the working day and disappearing overnight, stayed standing immobile in a swimming pool for 30 minutes (30’), continuously walking again for 30’ in the same pool and walking on ground for 30’ without interruptions in a randomized sequence. Leg volume, ankle circumference and epifascial thickness of both legs were assessed each day before and after each intervention. Results Leg volume showed a median reduction by 4.20% (IQR 5-3.6) (p = 0.0002) after 30’ of immobile standing immersion and by 6.50% (IQR 7.30-5.61) (P < 0.0001) when the patients walked in the pool. Ankle circumference showed a median reduction by 2.89% (IQR 4.23-2.03) (p = 0.02) with the subjects staying standing still in water and by 5.98% (IQR 7.47-4.14) (p = 0.0002) after 30’ walking in the pool. Epifascial thickness showed a median reduction by 24.35% (IQR 35.26-22.5) (P < 0.0001) when the volunteers remained standing still and by 32.66% (IQR 36.91-28-84) (P < 0.0001), when walking in water. Leg volumetry showed a median reduction by 0.20% (IQR-0.44-0.29) (p = 0.375) after walking on ground for 30’. Ankle circumference and epifascial thickness did not show any difference walking on ground compared to baseline situation. Conclusions This study showed that 30’ of WI, especially when associated with walking, reduced leg volume in otherwise heathy subjects with OE and that walking outside the water did not.

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